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EDITORIALS: Robert Buckman Communications and emotions BMJ 2002; 325: 672 [Full text]

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Empathic Responses

Lewis Walker   (28 September 2002)

The Best & The Worst.

Primrose May   (29 September 2002)

Empathic Responses 28 September 2002
Lewis Walker, General Practitioner Ardach Health Centre, Buckie, Scotland Send response to journal: Re: Empathic Responses	Dear Editor, I am not at all certain that Buckman is describing a genuinely empathic response in this article. He seems to make the common mistake that attempting to experience what the patient is feeling is akin to having had, or currently have, the clinical condition the patient is suffering from. The structure of empathy is to take a second position perspective, to attempt to "step into the patient's shoes" and IMAGINE what it feels like to have that experience, regardless of your own previous or current medical history. This gives an opportunity to glean far more information from the clinical encounter.The depth of rapport established in so doing can be therapeutic in it's own right, and is certainly something which patients, if they are to be believed, value highly in their physician. This kind of skill is even more important in highly emotionally charged situations when failure to take this perspective allows for poor decision making. Of course taking this second position perspective exclusively in a consultation can be ultimately unhelpful and lead to fatigue and burnout. There needs to be a sensitive balance between this and the first and third person perspectives. So what are these and how are they helpful? First postion is simply seeing the situation from your own perspective, feeling your own feelings and expressing these as "I" statements. Third position is more like a detached observer, a "fly on the wall", an attempt to step back from the emotions of the situation and bring an "objective" gaze. Alas too many doctors find themselves stuck in this position, a distanced "cold fish", giving a major lack of empathic response, a technician rather than a human being. No one position is "correct" or "true". All three positions contribute different types of information in a consultation. WISDOM lies in the synthesis of all three to the exclusion of none. Traversing positions in this way is actually a highly learnable skill and Buckman need have little concern that stepping momentarily into the patients shoes is unhelpful. Quite the opposite, it allows us to hand over information sensitively especially when breaking bad news. Lewis Walker Ref. Walker L. Consulting with NLP: neuro-linguistic programming in the medical consultation. (2002) Radcliffe Medical Press
The Best & The Worst. 29 September 2002
Primrose May, Retired Teacher N/A Home : TR18 5BZ Send response to journal: Re: The Best & The Worst.	I am a patient of the NHS. It is a wonderful institution where too few professionals are trying to do too much for too many patients with too few facilities. I have experienced some of the best care, but unfortunately, also some of the worst. What use are the possession of excellent surgical skills, combined with a dirth of communication skills. Those people can save people physically, but destroy them mentally and emotionally. That destruction impinges on one's physical condition. It also robs you of the trust you should have in the Health Community. One person can do that! Sad to say, those few people probably do not even know they are being so cruel. 'Cruel' might seem a harsh and emotive word to use, but are there any others? Ignorance? Vindictive? Terrifying? Evil? Do these people realise what harm they do when they are unable to communicate? The saddest thing of all, is that when compassionate doctors or nurses come along, and they say something encouraging and positive, one finds it difficult to believe them, and all because one person was so negative and destructive. When you do not have good health, and you rely on the NHS for a lot of care, you spend a lot of time being frightened of the next Health Professional who cannot communicate. How do you tell the difference, until they open their mouths? By then it's too late. You're back in the hole of fear.